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Pediatric Kidney Stones Research

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The incidence of pediatric kidney stones (nephrolithiasis) has increased dramatically over the last 25 years for reasons that are not well-described. This has resulted in uncertainty of how to best evaluate children with suspected kidney stones and how to effectively decrease recurrence for patients whose first stone developed during childhood. This line of CPCE research, led by Gregory Tasian, MD, MSc, MSCE, seeks to address these knowledge gaps.

Temporal Trends of Adult and Pediatric Kidney Stone Incidence

This study seeks to define the annual incidence of kidney stones among children and adults over a 16-year time period in South Carolina. Using a serial cross-sectional design and generalized linear models, we are estimating the incidence rates of nephrolithiasis and determining how these rates differ by age, sex, and race. The preliminary results suggest the incidence has increased the most among adolescents, particularly females, and among African-Americans, which are a reversal of historical trends.

Temperature and Kidney Stone Risk

This study seeks to define the association between the temperature of a person’s environment and the risk of presenting with kidney stones. Using a case-crossover design and distributed lag nonlinear models, we are estimating the relative risk of kidney stone presentation associated with the daily temperatures on patients who sought treatment for kidney stones in the cities of Atlanta, Chicago, Dallas, Los Angeles, and Philadelphia. The results demonstrated that high and low mean daily environmental temperatures increased the relative risk of kidney stone presentation in most cities.

Antibiotics and Kidney Stone Risk

CPCE researchers used electronic health records from the United Kingdom to look at antibiotic exposure in nearly 26,000 patients with kidney stones, compared to nearly 260,000 patients without kidney stones. For five classes of antibiotics, they found increased risk of kidney stones. These results may partially explain the increase in kidney stones among pediatric patients, especially given that children are prescribed antibiotics at higher rates than adults. Furthermore, this work advances what we already know about how antibiotics can alter the composition of the microbiome, and it supports our investigators’ efforts to reduce children’s exposure to unnecessary antibiotics.

Mobile Device Hydration Reminders for Adolescents With Kidney Stones

Although previously studied in adults, this prospective cohort study is the first to explore the barriers to water intake among adolescents with pediatric kidney stones, or nephrolithiasis. Young adults may exhibit different barriers than adults, and therefore require a different approach to prevention. For instance, youth differ from adults in their cognitive control and decision-making processes, as well as differences in their daily activities (e.g., school/summer vacation vs. work).

We are utilizing an approach called Ecological Momentary Assessment (EMA), where real-time data is gathered throughout the day in subjects’ normal environments through mobile devices. Through EMA, we will identify the setting characteristics associated with water intake, including time, temperature, place, activity, mindfulness of and attitudes towards water, and access to beverages.

The focus on real time momentary assessment—collecting data about what is going on right at the moment or over the very recent past—provides several distinct advantages over other methods such as focus groups:

EMA overcomes recall bias for children as young as age seven because subjects are asked about what is happening at a particular moment in time

EMA allows understanding of how events, behaviors, and experiences play out over time, context, and place. Drinking water is a discrete event that may be influenced by physiologic, psychological, and situational factors that change over the course of the day and year, so this is of particular importance.